What is a Speech-Language Pathologist

"Language is the single best predictor of future school progress in a young child"
(Capute, Palmer & Shapiro, 1987)

A Speech-Language Pathologist (SLP) is a highly trained professional who is trained to manage all human communication disorders (pathology). At the Child Development Centre (CDC), the SLP helps children from birth to pre-school age to overcome and prevent communication and hearing disorders. The SLP uses a wide variety of specialized instrumentation and procedures to screen hearing and assess speech and language. The SLP participates in programs, ranging from direct (one-on-one) therapy through group therapy to consultation sessions, and on teams that provide consultative and direct treatment services. The SLP is responsible for counselling of clients and families and for appropriate referral to other professionals.

The SLP is concerned with children's communication skills, both verbal and non-verbal which include:

Understanding and using language - using words, sentences and telling stories

Social uses of communication - using facial expression, body language and gesture when greeting people, playing with peers, holding a conversation, etc.

Clarity of speech, including the ability to produce and combine the speech sounds of the child's language

Correct use of the voice · Alternative or augmentative ways of communicating, such as sign language or picture symbols

Fluency

Pre-literacy skills

The Speech-language Pathologist also manages feeding difficulties in young children which involve the ability to suck, chew and swallow.

Communication is a skill which involves the whole child. It is therefore necessary for the SLP to take a broad view of the child and are therefore concerned with the child's hearing, general health, attention, memory, personality, socialization, sensory-motor skills, movement skills, play and concept development. Family needs and lifestyle are also considered in selecting treatment content and options.

The pre-school years are the most critical for speech and language development. Referrals to a SLP are made by family doctors, public health nurses, Infant Development specialists, Supported Child Care consultants, preschool teachers or social workers. Self-referrals can also be made.

At the Quesnel & District CDC the SLP is required to have a masters degree in Speech-Language Pathology, and be a member of both the Canadian Association of Speech-Language Pathologists and Audiologists (CASLPA) and the British Columbia Association of Speech Language Pathologists and Audiologists (BCASLPA). Both associations demand adherence to a code of ethics as well as meeting continuing education requirements. Their websites are:

Services

"We have two ears and one mouth so that we can listen twice as much as we speak"
- Epictetus

The Speech-Language Pathology (SLP) program supports parents and caregivers of children birth to 5 years with communication problems. Services are provided within a multi-, inter- and trans-disciplinary team approach. The SLP work closely with the CDC Physiotherapist, Supported Child Care consultants and aides, Infant Development Program workers, Family Services worker, public health nurses, Occupational Therapist and early childhood educators. Liaison with referring doctors and other professionals are pursued.

The services include:

Evaluating the communication and related abilities

Assisting parents/caregivers to optimize communication development

Provide individual or group therapy sessions when needed

Provide home and/or day-care programs if needed.

Who Needs SLP Services?

Children who exhibit any of the following characteristics:

unintelligible speech

delayed language development

hearing loss

repeated incidents of middle ear infection

poor listening skills

presents with a syndrome e.g. Down Syndrome, FAS, Fragile X, etc.

attention deficit and poor concentration

acquiring more than one language simultaneously

hoarse or soft voice

not communicating using speech

unfluent speech

Where Are Services Delivered?

At the CDC - children may be brought in and seen with their caregivers, be seen in our pre-school, or they may be pulled out for a one-on-one or small group session.

In the home, especially in the case of very young babies.

Community preschools and daycares.

How Do I Access SLP at the CDC?

The CDC has an open referral system, i.e. any parent or professional with a concern about a child can call us to arrange for a screening. All referrals are accepted and will go through the intake committee where the appropriate action will be discussed.

What are the Waitlists Like?

Initial consultations will take place as soon as possible. Children needing periods of weekly treatment may have to wait for a vacant suitable opening in a direct treatment timeslot, which can be lengthy. During that time the child will be referred to an appropriate program within the CDC to provide bridging support. The family may also meet with the therapist on a regular basis for consultations during that time and some children are adequately managed by consultations only.

Programs

Weekly/Bi-weekly Direct Treatment

Description:
The child is seen weekly or every second week by the therapist for a set period of time. Caregivers are encouraged to be present. Caregivers will be given strategies to reinforce treatment goals outside of therapy sessions, i.e. caregiver consultation is an inherent part of a direct treatment program.

Treatment sessions will most often take place at the Centre but may be offered at home, in community daycares or preschools etc.

Purpose:
To facilitate communication development or feeding skills in children who are at an appropriate point of readiness, as determined by the therapist. Whether or not this treatment model is offered may also depend on the caregivers' willingness and ability to attend sessions and follow through with therapy strategies in between sessions.

Duration:
Variable. Many children will receive periods of direct treatment lasting several weeks or months.

Group Treatment

Description:
Each group (usually 2 - 4 children) will have a primary focus, e.g. language skills or speech sound development. The therapist will select suitable children based on the communication goals for the group. Some groups will require parent/caregiver participation. Groups in a pre-school where the goals are general language enrichment and fostering of good listening skills are provided when needed and requested.

Purpose:
To facilitate communication skill development within a group setting. This treatment model offers opportunities to promote social interaction, incidental teaching, peer modeling, and functional application of communication skills and generalization of skills.

It is an appropriate model for children who are able to benefit from peer interaction, who can comply with routines, and who are able to maintain sufficient attention to task. The individual child must have communication skills which are at approximately the same level as the rest of the group.

Duration:
Variable, from 4 weeks up to several months.

Consultation Program

Description:
The therapist will meet with caregivers as often as once every two weeks or as infrequently as once every 4 months. The child will usually be present.

Purpose:
To teach parents and other caregivers to play the key role in the children's communication development. The therapist's role is to provide information, support, guidance about strategies and goals and to monitor the child's progress.

This treatment model is suited to children who learn best through the incidental teaching opportunities that arise during natural daily routines at home and at daycare/preschool. It suits children whose progress is relatively slow, so that time is allowed for change to occur before the therapist's input is needed again.

It also suits children with mild disorders, who are able to learn sufficiently from strategies carried out at home and at preschool or daycare. Infants and children presenting with feeding difficulties as the primary problem are well managed with consultations.

Duration:
Usually as long as is needed, i.e. may be ongoing.

Waitlist

Description:Children may be placed on a therapy waitlist for services because there is currently no opening for them. During the waiting time the child will be supported by generalists (IDP or SCC consultants) in the CDC who will follow a therapy program with the child. While on the therapy waitlist they may be reviewed from time to time. Parents may also request consultations. Children are taken off the waitlist when a suitable opening in a direct treatment or consultation program becomes available.

When a weekly direct treatment spot becomes available, children on the waitlist as well as on consultation programs may be considered.

Inactive

Description:
Children are not receiving any form of treatment nor are they on the waitlist. The child's file at the Centre remains open.

Purpose:
To keep a record of, and state of readiness for, children who were in a treatment program but are temporarily unable to access services due to:

inability to contact

family circumstances

lengthy illness or medical treatment

poor attendance

temporarily out of the area, with notice

transportation difficulties

Where possible, the decision to place a child in the inactive category is made in conjunction with the parents and with the expectation that the situation will change within months, i.e. that treatment will be resumed. The original waitlist date is retained. If inability to contact the family or poor attendance persists beyond a reasonable limit, the child may be discharged.

Discharge

Children may be discharged for the following reasons:

child's communication is age-appropriate

therapy goals have been met

spontaneous progress is expected to occur

child should benefit sufficiently from another programme, e.g. preschool

When children are referred for services to the Speech-Language Pathology program, they are assessed and either offered services immediately or placed on a waitlist with the appropriate bridging support from a generalist. Children who have been recently assessed by a Speech- Language Pathologist at another agency, or have been receiving treatment from that therapist, may be placed directly on therapy waitlist. Infants with dysphagia and incipient stutterers are seen immediately.

When taking children off the waitlist, several factors are taken into account:

The length of time since being placed on the waitlist.

The match between the family's expressed wishes for a particular type, time or place of service and the therapist's time slot which has become available.

The accessibility of the child and caregivers, e.g.

family are still in town

attendance is adequate at the Centre, if that is where therapy is to take place

if the child is in a community placement or at home, there is reasonable access to the child.

When contacted regarding treatment onset, the parents/caregivers are still desirous of treatment.